Food infection /Food Poisoning

Food infection /Food Poisoning results from ingestion of live pathogenic organisms which
multiply in the body and cause disease.

Botulism: Food poisoning caused by Clostridium botulinum

 Botulism is a neuro paralytic intoxication caused by ingestion of preformed enterotoxin

in food produced by Clostridium botulinum.

Etiological agent for Botulism:

 Clostridium botulinum is gram positive, anaerobic, rod shaped, spore forming bacteria.
 They produce 8-types of neurotoxins (A, B, C1, C2, D, E, F and G) in food.
 Therefore, Clostridium botulinum strains are classified into 8-group on the basis of type
of neurotoxin they produce.
 Type A, B, E and F cause botulism in human being and type C and D cause botulism in
other animals.
 It usually produces gas in food. It may or may not be proteolytic.
 Proteolytic strain produces various bad smelling compounds like H2S in food.
 But, in case of non-proteolytic strain, spoilage cannot be judged by smell of food.
 Similarly, bad odor is not developed in low protein or non-protein food.
 Various factors affect spore germination growth and toxin production by C. botulinum.
 Moisture below 30% inhibit toxin production. Similarly, salt concentration of 8% or more
prevent neurotoxin production in food.
 Similarly, neurotoxin is not produced if pH of food is 4.5 or below.
 Composition of food determine type of toxin produced. For.eg. food containing milk or
casein give more toxic type of type A toxin.
Properties of botulinum toxin (Botox):
Toxin is produced in food during growth and autolysis of bacteria.
Proteolytic strain produce toxin in active form but some non-proteolytic strain produce toxin in
inactive form.
This inactive toxin become active in stomach by acid hydrolysis.
Unlike enterotoxin of S. aureus, this neurotoxin is damaged by heating at 80oC for 10 minutes.
Botulinum toxin is most toxic chemical found in nature.
Pathogenesis of botulism:
Botulism occur by ingestion of pre-formed neurotoxin on food.
After ingestion it is absorbed by cell of upper intestinal tract, then enters into lymph then into
blood.
From blood, it reaches neuromuscular junction and binds to nerve ending. After binding it inhibit
release of acetylcholine neurotransmitter that gives paralysis of muscle.
If this paralysis extends to breathing muscle, death occurs by respiratory failure.
Infant botulism:
In adult botulism is intoxication i.e. it is caused by ingestion of preformed neurotoxin
of Clostridium botulinum in food.
In adult, ingested Clostridium botulinum cannot multiply in intestinal tract.
It is because Clostridium botulinum is highly acid sensitive and it is killed by stomach acidity.
Furthermore, this bacteria is very less competitive and cannot compete with normal flora of
intestinal tract.
So, in case of adult botulism occurs only by ingestion of pre-formed neurotoxin, but not by
ingestion of bacterial cell but in infant stomach is not acidic and intestinal normal flora are not
fully developed.
Therefore, ingested Clostridium botulinum multiply and produce endotoxin in intestinal tract of
infant.
So, botulism in infant is an example of food infection.
Symptoms of Botulism:
Incubation period is 12-36hrs, but it may be shorter or longer.
Earliest symptom includes acute digestive disturbance followed by vomiting, sometime diarrhea,
fatigue and headache.
After above symptoms typical neurological symptoms appear. They include double vision,
difficulty in speaking and swallowing, mouth becomes dry and tongue swells.
Paralysis of involuntary muscle occurs. Paralysis of respiratory muscle results in death.
Treatment of Botulism:
Treatment of botulism can be separated into three processes:
First treatment is removal of unabsorbed neurotoxin from intestinal tract. For.eg. by inducing
vomiting.
Second treatment involves neutralization of neurotoxin by ingestion of antibody (anti-toxin). It is
the only one successful treatment of botulism.
Third treatment involves curing of symptoms. For.eg. by artificial breathing.
Prevention and control of botulism:
Preventing contamination of food:
For this purpose, food should be kept away from soil and dust because its natural habitat is soil.
Preventing growth and toxin production in food:
It can be done by making the food aerobic by adding chemicals, heat treatment etc.
Damaging neurotoxin in food:
It can be done by heating the food at 80oC for 10 minutes just before eating.

Staphylococcal food poisoning

Staphylococcal food poisoning is an acute intoxication that occurs when food contaminated
with enterotoxin produced by this bacterium is consumed. staphylococcal food poisoning is
considered to be among the most common causes of gastroenteritis worldwide. The presence of
staphylococcal enterotoxin in food is usually due to cross contamination of ready to eat food
with either raw food or, most likely, contamination from a food handler that is
carrying Staphylococcus aureus.

Source of contamination of Staphylococcal food poisoning

  S. aureus is a gram-positive, non-sporing pathogenic food-borne bacterium that can be
isolated from a wide range of environments (soil, water, and air).
 The main source of enterotoxin contamination is associated with food handlers carrying
enterotoxin in their nose or hand and through meat grinder’s knives to the food products and
food contact surfaces. 
 They are also transmitted via physical contact and through respiratory secretions while
coughing and sneezing.
 In raw food, the competency of S. aureus is low with indigenous microbiota, therefore;
improper handling of cooked or processed foods and storage at inappropriate temperature also
serves as the main reservoir of contamination.
 S. aureus are also found in poultry and dairy animals like cattle, sheep, and goats if affected
by subclinical mastitis.
 Foods that are frequently contaminated by SEs include meat and meat products, poultry and
egg products, milk and dairy products, raw salads, cream-filled pastries, sandwich fillings, ice
creams, and salted food products.

Causes

For staphylococcal food poisoning to occur following the ingestion of a given food, two
conditions are necessary. First, S. aureus has to be present in the food; second, foods stored at
incorrect temperatures and time allow growth of this pathogen and the production of enterotoxin.
The foods that have been most frequently in cases of staphylococcal food poisoning are poultry
and cooked meat products such as ham or corned beef. Other foods implicated were milk and
milk products, canned food and bakery products.
Symptoms include:

 vomiting
 nausea
 diarrhea, usually watery but sometimes with blood
 cramps
 other symptoms may include mild fever, weakness, dizziness and chills.

Symptoms usually start 1 to 10 hours after exposure and go away in 1 to 2 days. In some cases,
the illness may be more severe. If you have serious symptoms, you should see your doctor. 

Test & Diagnosis

Staphylococcal food poisoning can be confirmed if the enterotoxin or large numbers of S.
aureus are found in the food. S. aureus can also be detected in stool samples from patients. 

Treatment
 Fluid therapy and rest cure are suggested.
 Treatment with proper antibiotics may lower the symptoms but could affect adversely if the
toxins are resistant.
 Therefore, the natural flora of the intestinal tract eliminates the growth of Staphylococci.

Salmonellosis

Salmonellosis is a serious disease that has a clinical spectrum of gastroenteritis and typhoid
fever.
 Salmonella Characteristics
 Gram-negative bacteria
 Facultative anaerobes
 Motile, rod-shaped bacteria
 Non-spore former
 Non-capsulated (except S. Typhi and S. Paratyphi)
 Growth temperature ranges from 5 to 45°C (Optimum temperature – 35 to 37°C)
 Broad pH range 3.8 to 9.5
 Resists bile salts
 Produces H2S
Sources of transmission of Salmonellosis
 Poultry is the major reservoir of Salmonella and is transmitted to other organisms through the
fecal-oral route.
 Salmonella species are also present in the GI tract of many animals, birds and reptiles.
 Salmonella was first isolated from the intestine of turkey flocks and chicken broiler flocks.
 The water and foods get contaminated from the feces and/or urine of the infected humans or
animals.
 Consuming contaminated water and food infects the healthy individual and cause infections.
 The person-to-person also get infected through fecal-oral transmission and/or by handling
contaminated food products or utensils and poor hygiene practices.
 Consuming tropical fish from contaminated water, raw meats, eggs, milk and milk products,
salad dressing, cake desserts and topping, cocoa, peanut butter and chocolate are the possible
source of Salmonella infection.
  Common symptoms of gastroenteritis are nausea, vomiting, diarrhea, abdominal cramp,
myalgia, headache, fever and chills.

Clinical manifeatations
 The process of Salmonellosis starts after 6 to 48 hours of ingestion in case of gastroenteritis
(food poisoning).
 The incubation period depends on the dose of bacterial cells ingested from contaminated food
and water.
  Common symptoms of gastroenteritis are nausea, vomiting, diarrhea, abdominal cramp,
myalgia, headache, fever and chills.
 The infection lasts only for 2 to 7 days and is self-limiting.
 In the case of enteric fever i.e, typhoid fever, the complication begins after 10 to 14 days of
ingestion of bacterial cells.
 The symptoms are non-specific at the first week of infection with constipation, headache and
mild fever.
 In the second week, the patient starts to develop myalgia,  continuous high fever, severe
headache,  abdominal distension, watery diarrhea and sometimes foul green-yellow stools.
 If untreated, patients may die from toxemia, myocarditis and intestinal hemorrhage.

Laboratory Diagnosis of Salmonellosis

1. Culture method

The commonly used lab media for the isolation of Salmonella species are Desoxycholate Citrate
Agar or XLD agar, Salmonella – Shigella agar and MacConkey agar.

If the sample is minimum, enrichment media are used such as tetrathionate or selenite F broth.
 Serology test

Widal agglutination test is done which measures the antibodies against the antigens of the
pathogen.

Food-Poisoning (Mycointoxications) Caused by Fungi:

Mycotoxins are chemical substances produced by a variety of fungi, e.g., aspergillius, penicillin,
Rhizopus, Fusarium spp., and mushrooms (poisonous; called toadstools). The illness that results
from the ingestion of foods containing fungal toxins is called ‘mycotoxicosis’.

Aflatoxins are one of the most potent mycotoxins produced by Aspergillus flavus and related
strains. It has been found that about 60% strains of A. flavus produce this toxin.

Aspergillosis is an infection, allergic reaction, or fungal growth caused bythe Aspergillus fungus.

It has many forms:

 Allergic bronchopulmonary aspergillosis (ABPA)

 Allergic Aspergillus sinusitis

 Aspergilloma

 Chronic pulmonary aspergillosis

 Invasive aspergillosis

 Cutaneous aspergillosis
Signs and Symptoms of Aspergillosis

The different types of aspergillosis can cause different symptoms.

Symptoms of ABPA are similar to those of asthma:

 Wheezing
 Shortness of breath
 Cough
 Brown or dark mucous (also known as sputum)
 Fever in rare cases
 Symptoms of allergic Aspergillus sinusitis include the following:
 Stuffiness

 Runny nose

 Headache

 Reduced ability to smell

Aspergilloma, also known as “fungus ball” in reference to the clump that can grow in a cavity in
your lung, has these symptoms:
 Cough

 Coughing up blood

 Shortness of breath
These are the symptoms of chronic pulmonary aspergillosis:
 Weight loss
 Cough
 Coughing up blood
 Fatigue
 Shortness of breath

Invasive aspergillosis tends to occur in people who are already sick from another medical
condition or have impaired immunity due to a condition or treatment such as chemotherapy, so it
can be challenging to determine which symptoms are related to an Aspergillus infection. That
said, symptoms of invasive aspergillosis in the lungs include the following:
 Fever

 Chest pain

 Cough

 Coughing up blood

 Shortness of breath
Symptoms of cutaneous aspergillosis, which is rare, include red to purplish plaques or papules.
Causes and Risk Factors of Aspergillosis

In most cases, aspergillosis is caused by a type of mold called Aspergillus fumigatus. (There are
180 species of Aspergillus, fewer than 40 of which are known to cause infections in people.) 
 

Food intoxication: Some bacteria produce harmful toxins which are present in food even if
pathogen has been killed. Organisms produce toxins when the food has not been hot enough or
cold enough. Toxins in food cannot be detected by smell, appearance or taste. Hence foods
which smell and appear good are not necessarily safe. One example of such an organism is
Staphylococcus aureus. Such organisms exist in air, dust, water. They are also present in the
nasal passage, throat and on skin, hair of 50 per cent of healthy individuals. People who carry
this organism, contaminate food if they touch these places on body while food handling.
Diarrhea is also one of the symptoms of this contamination. Parasites can also cause infestation,
e.g., worm infestation by tape worm in pork. In addition to this, food can be infested by pests and
insects.
 Food Standards

Effective food standards and control systems are required to integrate quality into every aspect
of food production and service, to ensure the supply of hygienic, wholesome food as well as to
facilitate trade within and between nations.

There are four levels of standards which are well coordinated

. a. Company Standards: These are prepared by a Company for its own use. Normally, they are
copies of National Standards.

b. National Standards: These are issued by the national standards body, Food Safety and
Standards Authority of India (FSSAI).

c. Regional Standards: Regional groups with similar geographical, climate, etc. have legislation
standardisation bodies.

d. International Standards: The International Organisation for Standardisation (ISO) and Codex
Alimentarius Commission (CAC) publish international standards

Bureau of Indian Standards (BIS):

The Bureau of Indian Standards (BIS), empowered by the Bureau of Indian Standards Act, 2016,
operates product certification schemes by which it grants licenses to manufacturers covering
practically every industrial discipline from agriculture and textiles to electronics.

BIS is functioning under the administrative control of Ministry of Consumer Affairs, Food &
Public Distribution. The certification allows the licensees to use the popular ISI mark, which has
become synonymous with quality products for the Indian and neighboring markets for over 55
years. Manufacturers complying with standards laid down by the BIS can obtain the ISI Mark
that can be exhibited on product packages. These standards have higher quality specifications
than those prescribed under AGMARK and FSSAI.

The BIS has laid down specification for mineral water and packaged drinking water and is the
licensing authority for the manufacture of mineral water and packaged drinking water in India.
IS Standards have been laid down for fruit and vegetable products, spices and condiments,
animal products and processed foods. The products are checked for quality by the BIS in their
own network of testing laboratories or in several public and private laboratories recognized by
them. Under BIS many of the standards are laid down based upon ISO (International
Organization for Standardization) standards which is a worldwide federation of National
Standard Bodies.

Constitution of the Bureau:  The Bureau consist members such as  the Minister in charge of
the Ministry, Minister of State, the Director-General of the Bureau, persons representing the
Ministries, state Governments, recognized consumer organizations, farmers, industry and trade,  
research institutions, technical, educational and professional organizations etc.

Powers and Functions of the Bureau

Establishment, Publication and Promotion of Indian Standards :  For the purpose of

formulation of Indian Standards in respect of articles or processes, technical committees of
experts are constituted. Such committees may include Division Councils, Sectional Committees,
Sub-committees and Panels and each of these councils have specified functions .

Procedure for Establishment of Indian Standards: Any Ministry of Central or State

Government, consumer organizations, industrial units, industry-associations, professional bodies,
can submit proposals to the Bureau for establishing a standard or for revising, amending, a 
standard by making a request in writing. Division Council concerned will assign the task of
formulating the standard to an appropriate Technical Committee. Later a draft standard prepared
and duly approved by a Committee shall be issued and widely circulated for a period of not less
than one month amongst the various interests concerned for critical review and suggestions for
improvement.  The appropriate Technical Committee shall thereafter finalize the draft standard
giving due consideration to the comments that may be received. The draft standard shall be
submitted to the Chairman of the Division Council concerned for adoption.  All established
standards shall be reviewed periodically, at least once in five years, to determine the need for
revision or withdrawal. Standards which there is need to revise or amendment shall be
reaffirmed.

Grant of License: Manufacturing units can apply for BIS license on a prescribed form along
with application fee and other documents such as location map of factory  list of manufacturing
and testing equipments, flow charts of the process, details of the technical staff etc.   BIS office
will do a preliminary inspection verify all documents and process. The product samples are
drawn and sent for analysis at BIS certified lab. After satisfactory inspection and sample report
of the product, license is granted 1 to 2 years which can renewed periodically.

Inspection :  The certified units are inspected by inspecting officers. The may be done at
manufacturing place, dispatch place or at the place where it is used. At manufacturing place the
inspection will also be for the QA systems, verification and validation. The Bureau shall
designate such of the officers of the Bureau as Inspecting Officers

STOP Marking: If there is evidence that the product is not as per the conforming standards and
agreed clauses, the licensee will be directed to stop marking. The reasons can be Non
conformance of products at manufacturing place or at market place, Non implementation of
Scheme of Testing of the products, Non availability of testing staff , Significant modification of
plant and machinery with out informing BIS, Relocation of plant and machinery, Prolonged
closure of the unit, Marking non conformed product, Marking standard mark other than that are
included in the license. The licensee can resume only after re inspection and satisfactory
compliance.

While the scheme itself is voluntary in nature, the Indian Government has, in public interest,
enforced mandatory certification on various products through various quality control orders
issued from time to time, under various acts. While BIS continues to grant licenses on
application, the enforcement of compulsory certification is done by the authorities notified in
such quality control orders. Overseas applicants can also be granted BIS certification for use of
ISI mark for their products under the Foreign Manufacturers Certification Scheme (FMCS). In
this connection, the Food Safety and Standards (Prohibition and Restriction on Sales)
Regulations, 2011 has prescribed mandatory certification under the BIS Act for the following
products: Infant formula (IS14433) Milk cereal based weaning food (IS1656) Processed cereal
based weaning food (IS11536) Follow up formula(IS15757) Packaged drinking water(IS14543)
Packaged mineral water(IS13428) Milk Powder(IS1165) Skimmed Milk Powder(IS13334) Partly
Skimmed Milk Powder(IS14542) Condensed Milk,Partly Skimmed and Skimmed Condensed
Milk (IS1166) The main objectives of BIS, include: a) harmonious development of
standardization, marking and quality certification b) to provide a new thrust to standardization
and quality control, and c) to evolve a national strategy for according recognition to standard
integrating them with the growth and development of production and exports.